Haggling over prices may seem more natural at a yard sale than a doc’s office. But pushing past any discomfort you might have about asking about the cost of treatment options may be worth it, according to a new study of more than 300 cancer patients at Duke Cancer Institute in Durham, N.C.
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“What was most surprising was that half of the people in the study said they wanted to talk about cost, but only 19 percent had,” says lead study author Dr. Yousuf Zafar, assistant professor of medicine. “But of those, half found that discussion with their doctors resulted in cut expenses.”
The barriers to such conversations include embarrassment, and a feeling that it’s not the doctor’s role to talk about cost—or that a doctor simply couldn’t help, says Zafar. “And some people say they want the best care regardless of cost.” Some may fear that cost equals quality, and that asking a doctor to trim costs may trim health benefits as well.
But such talks are crucial for your financial health, says Dr. Jeffrey T. Kullgren, assistant professor of internal medicine at the University of Michigan Medical School. “Thirty percent of non-elderly Americans who have private insurance are enrolled in health plans with high deductibles,” he says. “And 45 million Americans don’t have health insurance.”
So, what’s the best way to start the conversation? Try these pointers.
Be an informed consumer. “Before you even explore prices, understand what your health care needs are, what medications you are on, what services you will need and what your insurance covers,” says Kullgren. Many health insurance programs offer patients online access to see their medical history and to find physicians within their network, he says. Some insurance sites offer tools to estimate the cost of different providers within a network as well.
Shed the embarrassment. “Treatment can cause financial side effects—working more hours, spending savings, cutting vacations—and those need to be addressed,” says Zafar. “Bring a specific list of financial issues to your doctor, for instance, problems with co-payments. That gives the doctor specifics to work on.”
Talk with the whole healthcare team. “The physician needs to be involved because he’s the one ordering services,” says Kullgren. “But team-based care is where we’re moving toward in healthcare. So other team members—nurse, clinical pharmacist, people in billing, social worker—may be able to help as well.”
Shop for cost-efficient care. Some services don’t differ in quality, like laboratory tests, which have built-in safeguards, says Kullgren. “Looking around for the most cost-efficient care is good for non-urgent services. But if you’re having chest pain, we should not be having a conversation about cost.”
Speak up about repeated tests. If you know a doctor is repeating a test you had recently elsewhere, let him know. (But there may be a good reason to repeat it.) The website of Choosing Wisely [LINK TO www.choosingwisely.org], an initiative of the ABIM Foundation in Philadelphia, helps both doctors and patients sort through necessary versus unnecessary health care steps.
Investigate resources. Many health-related organizations like the National Cancer Institute offer information about financial resources for their related disease. Health Matters That Work lists financial resources by disease. The HealthWell Foundation in Gaithersburg, Md., grants financial help for co-payments, health care premiums and deductibles for some medications and therapies.
At the least, see if your doctors or hospital offers payment plans. “This goes back to the model of a small town doctor who figured out what his patients could pay,” says Kullgren. “A lot of that still happens informally.”
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